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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2013-3632

2. Registrant Information.

Registrant Reference Number: x

Registrant Name (Full Legal Name no abbreviations): x

Address: x

City: x

Prov / State: x

Country: x

Postal Code: X

3. Select the appropriate subform(s) for the incident.


4. Date registrant was first informed of the incident.

5. Location of incident.

Country: CANADA

Prov / State: ONTARIO

6. Date incident was first observed.


Product Description

7. a) Provide the active ingredient and, if available, the registration number and product name (include all tank mixes). If the product is not registered provide a submission number.


PMRA Registration No.       PMRA Submission No.       EPA Registration No.

Product Name: unknown

  • Active Ingredient(s)

7. b) Type of formulation.

Application Information

8. Product was applied?


9. Application Rate.


10. Site pesticide was applied to (select all that apply).

Site: Unknown / Inconnu

11. Provide any additional information regarding application (how it was applied, amount applied, the size of the area treated etc).

In 2012, the following treatments were applied to the hives: amitraz and antiobiotics treated for mites 3x last year. In 2013, the following treatments were applied to the hives: formic acid and amitraz. Information on crops located near the beeyards: corn was adjacent from the beeyard, and was planted on 2013-05-15. Bee kill was noted directly after corn was planted in field next to tree line where bees were located. Hives were less than 500m from field that was planted. There were lots of dandelions in full bloom along treeline where hives were located. Hives were moved that same day (May 16) to the holding yard.

To be determined by Registrant

12. In your opinion, was the product used according to the label instructions?


Subform IV: Environment (includes plants insects and wildlife)

1. Type of organism affected

Terr. Invrtbrt-Honey Bee/Inv.Ter-Abeille

2. Common name(s)

honey bee

3. Scientific name(s)


4. Number of organisms affected


5. Description of site where incident was observed

Fresh water



Salt Water

6. Check all symptoms that apply

Abnormal behavioural effects


Reproductive impairment

7. Describe symptoms and outcome (died, recovered, etc.).

There were a total of 30 colonies in the bee yard. There were 8 affected colonies. There were 501-1000 dead bees per colony. Dead bees were observed outside the hive. Bees were actively foraging at the time of the incident. Adult bee symptoms included shaking/trembling/twitching, crawling and disoriented. Additionally, the bees were just hanging out at the hive entrance. Brood symptoms included spotty brood pattern. Additionally the main brood symptom refers that there is not enough bees on the brood. Queen symptoms included emergency/supersedure queen cells, queen stopped laying, unusual laying pattern, failure of colony to re-queen itself.Sample of dead bees taken from affected hive, composite sample of dead bees, had positive detects for clothianidin. The weather at the time of the incident was sunny, dry, windy 15-20 km/h. Prior to the incident, there were an average of 18 frames of bees, 8 - 9 frames of brood, and 4 frames of pollen and honey each. The following pests were present in the affected bee yard in the past year; chalkbrood, varroa a mite and apiaries. After the incident, there were an average of 9 frames of bees, 8 - 9 frames of brood stay the same but fewer bees that are more scattered and spread out, and 4 frames of pollen and honey each. Additional food sources provided to the bees included sugar syrup.

8. a) Was the incident a result of (select all that apply)


8. b) i) How many times has the product been applied this year?


8. b) ii) What was the date of the last application?


9. Did it rain

9. a) During application?


9. b) Up to 3 days after application?


10. a) Was there a buffer zone?


10. b) What type?


10. c) What was the size of the buffer zone?

11. a) Were environmental samples collected and analysed?


To be determined by Registrant

12. Severity classification (if there is more than one possible classification, select the most severe)

13. Please provide supplemental information here